Division of Urology, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
Department of Urology, University of Minnesota, Minneapolis, MN, USA.
J Racial Ethn Health Disparities. 2023 Aug;10(4):1735-1744. doi: 10.1007/s40615-022-01357-9. Epub 2022 Aug 12.
The Dysfunctional Voiding and Incontinence Scoring System (DVISS) is a validated tool to evaluate lower urinary tract dysfunction (LUTD) severity in children. DVISS provides a quantitative score (0-35) including a quality-of-life measure, with higher values indicating more/worse symptoms. Clinically, variability exists in symptom severity when patients present to pediatric urology with LUTD. We hypothesized that symptom severity at consultation varied based on race, gender, and/or socioeconomic status.
All urology encounters at a single institution with completed modified DVISS scores 6/2015-3/2018 were reviewed. Initial visits for patients 5-21 years old with non-neurogenic LUTD were included. Patients with neurologic disorders or genitourinary tract anomalies were excluded. Wilcoxon rank sum tests compared scores between White and Black patients and between male and female patients. Multiple regression models examined relationships among race, gender, estimated median household income, and insurance payor type. All statistics were performed using Stata 15.
In total, 4086 initial patient visits for non-neurogenic LUTD were identified. Median DVISS scores were higher in Black (10) versus White (8) patients (p < 0.001). Symptom severity was higher in females (9) versus males (8) (p < 0.001). When estimated median income and insurance payer types were introduced into a multiple regression model, race, gender, and insurance payer type were significantly associated with symptom severity at presentation.
Race, gender, and socioeconomic status significantly impact LUTS severity at the time of urologic consultation. Future studies are needed to clarify the etiologies of these disparities and to determine their clinical significance.
排尿功能障碍和尿失禁评分系统（DVISS）是一种经过验证的工具，可用于评估儿童下尿路功能障碍（LUTD）的严重程度。DVISS 提供了一个定量评分（0-35），包括生活质量衡量标准，得分越高表示症状越严重。临床上，患有 LUTD 的患者到儿科泌尿科就诊时，其症状严重程度存在差异。我们假设，咨询时的症状严重程度因种族、性别和/或社会经济地位而异。
对单家机构的所有泌尿科就诊记录进行了回顾性分析，这些就诊记录都完成了改良的 DVISS 评分，时间范围为 2015 年 6 月至 2018 年 3 月。纳入标准为 5-21 岁的非神经源性 LUTD 初诊患者，排除标准为患有神经疾病或泌尿生殖系统异常的患者。采用 Wilcoxon 秩和检验比较了白人和黑人患者以及男女性患者之间的评分差异。多元回归模型用于分析种族、性别、估计的家庭中位数收入和保险支付类型之间的关系。所有统计分析均使用 Stata 15 完成。
共确定了 4086 例非神经源性 LUTD 的初诊患者。黑人患者的 DVISS 评分中位数（10）高于白人患者（8）（p<0.001）。女性患者（9）的症状严重程度高于男性患者（8）（p<0.001）。当将估计的家庭中位数收入和保险支付类型引入多元回归模型时，种族、性别和保险支付类型与就诊时的症状严重程度显著相关。
种族、性别和社会经济地位显著影响泌尿科就诊时的 LUTS 严重程度。需要进一步研究以阐明这些差异的病因，并确定其临床意义。
